{
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"FirstLineMailingAddress": "4617 S PIONEER RD STE 101E",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAINT GEORGE",
"MailingAddressStateName": "UT",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "435-266-3321",
"MailingAddressFaxNumber": "435-266-3322",
"FirstLinePracticeLocationAddress": "4617 S PIONEER RD STE 101E",
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"PracticeLocationAddressCityName": "SAINT GEORGE",
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"PracticeLocationAddressTelephoneNumber": "435-266-3321",
"PracticeLocationAddressFaxNumber": "435-266-3322",
"EnumerationDate": "10/07/2026",
"LastUpdateDate": "10/07/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "OLSEN",
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"AuthorizedOfficialCredential": "DNP/FNP-C",
"AuthorizedOfficialTelephoneNumber": "435-266-3321",
"Taxonomies": {
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"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}